Bulimia nervosa: the disorder of binge eating and vomiting

An eating disorder that is making a dent in our society: bulimia nervosa.

The bulimia nervosa is an eating and psychological disorder with severe consequences on the physical integrity and mental health of those who develop it. As such, it is a psychopathology that should be treated as soon as possible by mental health professionals.

In this article we will see which are its main characteristics, symptoms and treatment of this alteration.

What is bulimia?

Bulimia nervosa is a psychological disorder characterized by the tendency to binge eating in a virtually uncontrolled in a practically uncontrolled way, and soon after feel the need to eliminate from the body those ingested foods. In addition, it is associated with purging behaviors or behaviors aimed at compensating for the acquisition of calories (making oneself vomit, starting intense exercise, etc.) that appear right after these binges, and which are associated with feelings of guilt and worry for having been eating unnecessarily.

Therefore, it is an eating disorder, since it is based on a pathological dynamic of relationship with food through eating. Moreover, by affecting something as important as food intake and the functioning of the digestive system, it seriously compromises health, it seriously compromises health not only by producing malnutrition problems, but also because purging behaviors can lead to infections and very serious injuries.

Diagnosis

The bulimic syndrome is an eating disorder characterized by abnormal eating patterns, with episodes of massive food intake followed by maneuvers aimed at eliminating those calories. After these episodes, the subject usually feels sad, moody and has feelings of self-pity.

This disorder has a higher incidence rate among Western women between the ages of 18 and 25 years oldfrom all socio-cultural backgrounds.

Although bulimia nervosa encounters some diagnostic difficulties, the criteria provided by the DSM-IV and ICD-10 are very useful. According to the DSM-IV, these are the following diagnostic criteria:

• Presence of binge eatingcharacterized by the ingestion of a food in a short period of time, and the sensation of loss of control over its ingestion.
• Repeated inappropriate compensatory inappropriate and repeated binge eating behaviors aimed at not increasing body weight. These behaviors include provocation of vomiting, use of laxatives, diuretics, enemas, fasting and inappropriate exercise.
• Binge eating and compensatory behaviors are observed at least twice a week for a period of three months.
• Self-assessment is markedly influenced by body weight and silhouette.

On the other hand, bulimia nervosa must be distinguished from binge eating disorder, a very similar psychopathology but in which compensatory behaviors of food intake do not appear.

Types of bulimia nervosa

These are the main types of bulimia nervosa.

Purging type

During the episode of bulimia nervosa, the subject regularly induces vomiting or uses laxatives, diuretics or enemas. In this way, they intervene on their own body once the ingestion of food has occurred.

Non-purging type

During a bulimic episode, the individual uses other inappropriate compensatory behaviors, such as fasting or excessive exercisebut does not resort to purgative methods. In this way, an attempt is made to prevent the ingestion of food (at least in the short term) or the effects of this ingestion are not too much reflected in the body. through an obsessive tendency to exercise.

Clinical picture of bulimia

These are the aspects that characterize the development of this psychopathology.

Behavioral disturbances

The person affected by bulimic disorder presents in general a disorganized behavior, initially only linked to eating, but later also in other facets of his life. The behavioral pattern associated with eating is disorganized and unpredictable, unlike in the case of Anorexia.

Binge eating can vary in frequency depending on mood and availability. Purging behaviors are not regular and the fear of gaining weight is contingent on mood or other circumstances.

Purging behaviors

After episodes of large ingestions of food, bulimia patients become aware that the food eaten will make them gain weight; this possibility terrifies them, creates anxiety and they resolve these thoughts by eliminating what they have eaten through provoked vomiting, laxative abuse, diuretics or intense physical exercise.

The most common behavior is the provocation of vomiting, and the least common is the consumption of diuretics. In addition, vomiting and laxatives are often linked methods.

Alterations in cognition

The bulimic patient, in the same way as the anorexic, presents altered thoughts about food, body weight and figure. Both pathologies show a great rejection of the possibility of being overweight or obese.

Some bulimic patients come from anorexia nervosa anorexia nervosa when, as this disorder becomes chronic, it evolves into bulimia. At that moment they go from a strict control of their diet to an intermittent control, appearing binge eating and purgative behaviors.

Psychopathologies associated with bulimia nervosa

People who develop a bulimic eating disorder mostly show extensive associated psychopathology. Depression is the disorder most frequently related to bulimia, although it has also been found that bulimic patients score high on anxiety scales.

It is also very common for patients with this psychological alteration to present typical characteristics of the Body Dysmorphic DisorderAlthough it does not focus solely on weight or fat accumulation, it generates obsession with one's own appearance. This latter psychological disorder is characterized by nonconformity with one's appearance, usually focused on very specific physical features.

Medical Complications Associated with Bulimia Nervosa

There is a general symptomatology that is likely to be present in most people affected by bulimia nervosa. This set of symptoms are nonspecific and generally do not allow the disorder to be identified from these data. Apathy, fatigue, sleep disturbances and irritability may accompany loss of academic or work performance and neglect of self-care.

On examination of patients in the early stages of the disease, slight abdominal distention with constipation, hypertrophy of the parotid glands, wear on the dental enamel and abrasions on the back of the hands can already be seen.

Complications in the cardiovascular system include hypokalemia, which can produce severe ECG disturbances, with dire consequences. This major risk factor is due to the loss of potassium in the Blood caused by regular purging.

As for the endocrine systembulimia patients may have a normal menstrual cycle, but it is not uncommon that they may have irregularities or even amenorrheawith low estradiol and progesterone levels.

Treatment of bulimia nervosa

Particularly summarily, these are the main therapeutic goals for bulimia nervosa:

• Restoration of healthy nutritional patterns..
• Recovery of physical conditionStabilization of body weight, rehydration, correction of physical defects.
• Normalization of the psychic stateMood improvement, treatment for possible personality disorders, avoidance of substance abuse, correction of dysfunctional cognitive style.
• Restoration of family relationships: increasing participation, communication and re-establishing functional patterns and roles.
• Correction of social interaction patterns: accepting the disorder, coping with failures, accepting responsibility, rejecting demeaning social frameworks.

Bibliographical references:

• Cash, T. F.; Deagle, E. A. (1997). The nature and extent of body-image disturbances in anorexia nervosa and bulimia nervosa: A meta-analysis. International Journal of Eating Disorders. 22(2): pp. 107 - 126.
• Cooper, P.J.; Fairburn, C.G.. (1993). Confusion over the core psychopathology of bulimia nervosa. The International Journal of Eating Disorders, 13(4): 385 - 389.
• Fisher, M.M.; Rosen, D.S., Ornstein, R.M.; Mammel, K.A.; Katzman, D.K.; Rome, E.S.; et al. (2014). Characteristics of avoidant/restrictive food intake disorder in children and adolescents: a "new disorder" in DSM-5. The Journal of Adolescent Health. 55 (1): 49–52.
• Jarne, A. y Talarn, A. (2011). Manual de psicopatología clínica. Madrid: Herder.
• Palmer, R. (2004). Bulimia nervosa: 25 years on. The British Journal of Psychiatry: the Journal of Mental Science 185 (6): 447 - 448.
• Sarason, I.G. y Sarason, B.R. (2006). Psicopatología. Pearson Prentice Hall.